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Extended menstual bleeding, fibroids, cyst. Advised surgery. CA125 and CBC test done. What can be done?

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Posted on Sun, 15 Jul 2012
Question: Dear Dr,

The menstural cycle commenced on April 24, 2012 last time and slight bleeding continued till May 13, 2012 and then stopped. I had undergone US which revealed the following (as per the report):

"UTerus is bulky and lobulated in appearance, Intramural Hypoechoic Fibroids measures - 4.2x3.5 cm and 3.2x2.5cm seen within posterior myometium causing antrior displacement of endometrium. Endometrium thickness is of 6.2mm. Cystic lesions showing thin XXXXXXX septa seen in left adnexal region likely left ovarian cyst (measures - 5.9x3.9 cm). Right Ovary Normal".

The local gynocologist advised immediate surgery. She even asked a CA125 which indicated 192.50.

We had been to another gyncologist who also advised for surgery but has asked to control the diabetes before surgery. She has askedto wait for about a month and go for another round of US (Pelvis) and return. She has dismissed that CA125 is not required at this stage as there is no requirement as per the US clinicals.

I am 43 years old. Pre-Menapusal. Have been pregnant before (but did not go through the preganancy for personal reasons). Am Type II Diabetic (am on 28 ml insulin). No other ailment.

Please advise.

I XXXXXXX also provide the fresults of the following tests which I had undergone.

CBC (Complete Blood Count):
* Haemoglobin: 13.7 gm/dl (reference range: 12-15)
* Packed Cell Volume: 40.6% (rr: 40-50)
* Total Leucocyte Count: 7.5 10-9/L (rr:4-11)
* RBC Count: 4.64 (rr: 3.8-4.8)
* MCV: 87.7 (rr: 80-100)
* MCH: 29.5 (rr: 26-34)
* MCHC: 33.7 (rr:32-36)
* Platelet COunt: 291 (rr: 150-450)
* RDW: 13.8% (rr: 11.5-14.5)

Differential Leukocyte Count
* Neutrophils: 71
* Lymphocytes: 24
* Monocytes: 03
* Eosinophils: 02
* Basophils: 00

CA 125 (Ovarian Cancer Marker)
* CA 125 : 190.5 (rr: <35)
* CEA (Carcino Emryonic Antigen): 1.29 (rr: <3)
doctor
Answered by Dr. Chetna Jain (14 hours later)
hi
You have fibroids which are displacing the uterine lining hence should cause heavy prolonged menses.
But you had menses problem for the first time.
fibroids are essentially noncancerous hence you should not have fear of malignancy.
but the CA-125 values are high, in this scenario pl do an MRI pelvis with contrast.If MRI is not suggesstive of abnormal ovarian mass then you will need removal of the affected ovarian tissue which should be sent intraoperatively for frozen section biopsy and if suspected malignant then surgery should be more extensive.Fibroids eventually will cause heavy flow and will shrink at menopause.
verify the findings by an MRI because you need to take important decision

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chetna Jain (12 hours later)
What do the following findings suggest.
* thin XXXXXXX septa in the cyst,
* size of the cyst around 5.9 cms,
* right ovary being noirmal - indicating unilateral cyst

Can we have a broad idea. We are worried.

Thanks and regards.
doctor
Answered by Dr. Chetna Jain (3 hours later)
sepatated ovarian cysts are common and they dont mean anything per se.
However compared to cysts without septae , septa ones are more likely to be cancerous ( marginally ).
Ovarian cyst over 5 cms is a medium sized cyst and indicates need of removal.
the need of removal is high in view of raised CA-125.
If one sided ovary is affected its aclled unilateral, when both the ovaries are affected they are called bilateral.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Chetna Jain

OBGYN

Practicing since :1990

Answered : 236 Questions

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Extended menstual bleeding, fibroids, cyst. Advised surgery. CA125 and CBC test done. What can be done?

hi
You have fibroids which are displacing the uterine lining hence should cause heavy prolonged menses.
But you had menses problem for the first time.
fibroids are essentially noncancerous hence you should not have fear of malignancy.
but the CA-125 values are high, in this scenario pl do an MRI pelvis with contrast.If MRI is not suggesstive of abnormal ovarian mass then you will need removal of the affected ovarian tissue which should be sent intraoperatively for frozen section biopsy and if suspected malignant then surgery should be more extensive.Fibroids eventually will cause heavy flow and will shrink at menopause.
verify the findings by an MRI because you need to take important decision